PTPS-12INTENSIVE CHEMOTHERAPY FOLLOWED BY REDUCED RADIATION DOSE FOR INTRACRANIAL NON-GERMINOMATOUS GERM CELL TUMORS

PURPOSE: It is well known that an intracranial non-germinomatous germ cell tumors (NGGCT), especially the patients who demonstrated high level of serum tumor marker has poor prognosis after standard treatment of chemotherapy and whole brain and spinal radiation. The radiation for childhood can be induce significant neurodevelopmental, neuroendocrine, somatic growth, cognitive impairments and secondary tumors. The objective of this study was to determine whether intensive chemotherapy followed by reduced radiation dose is effective in patients with poor prognosis group of intracranial NGGCT. PATIENTS AND METHODS: We have treated 15 patients (mean age 17 y.o.) with poor prognosis group of an intracranial 24 NGGCTs. The serum β-HCG ranged from 0 to 151052 mIU/ml and AFP ranged from 0 to 4120 ng/ml. The NAT (neo-adjuvant therapy), which is preceding chemotherapy before surgery, was performed in 9 patients which presented with serum β-HCG of over 500 mIU/ml or AFP 500 ng/ml. As chemo-radiotherapy, the ICE regimen (ifosfamide, cisplatin, etoposide) and whole brain (30Gy) and spinal (24Gy) irradiation was used for 9 patients of poor prognosis group from 1998 to 2006. The intensive regimen (cisplatin, etoposide, cyclophosphamide, bleomycin, carboplatin) and reduced radiotherapy (whole ventricle radiation 30Gy) have been induced for 6 patients since 2007. RESULTS: Mean follow-up period is 76 months. In ICE regimen, five of nine (56%) died (CSF dissemination: 3, secondary GBM: 1, sepsis: 1). In intensive regimen, none died and had serious complications. The initial chemotherapy achieves complete remission in 33%. The 3-year, 5-year and 10-year survival rate of all patients was 68%, 68% and 51%, respectively. The 5-year survival rate of the ICE and intensive regimen was 50% and 100%, respectively. CONCLUSION: Intensive chemotherapy followed by reduced radiation dose and field for poor prognosis group of intracranial NGGCT was safe and expected favorable prognosis and reducing or avoiding late effects.